Complex molecular profile of DNA repair genes in epithelial ovarian carcinoma patients with different sensitivity to platinum-based therapy

Epithelial ovarian carcinoma (EOC) is known for high mortality due to diagnosis at advanced stages and frequent therapy resistance. Previous findings suggested that the DNA repair system is involved in the therapeutic response of cancer patients and DNA repair genes are promising targets for novel therapies. This study aimed to address complex inter-relations among gene expression levels, methylation profiles, and somatic mutations in DNA repair genes and EOC prognosis and therapy resistance status. We found significant associations of DUT expression with the presence of peritoneal metastases in EOC patients. The high-grade serous EOC subtype was enriched with TP53 mutations compared to other subtypes. Furthermore, somatic mutations in XPC and PRKDC were significantly associated with worse overall survival of EOC patients, and higher FAAP20 expression in platinum-resistant than platinum-sensitive patients was observed. We found higher methylation of RAD50 in platinum-resistant than in platinum-sensitive patients. Somatic mutations in BRCA1 and RAD9A were significantly associated with higher RBBP8 methylation in platinum-sensitive compared to platinum-resistant EOC patients. In conclusion, we discovered associations of several candidate genes from the DNA repair pathway with the prognosis and platinum resistance status of EOC patients, which deserve further validation as potential predictive biomarkers.

Radiotherapy Versus Inguinofemoral Lymphadenectomy as Treatment for Vulvar Cancer Patients With Micrometastases in the Sentinel Node: Results of GROINSS-V II

PURPOSE

The Groningen International Study on Sentinel nodes in Vulvar cancer (GROINSS-V)-II investigated whether inguinofemoral radiotherapy is a safe alternative to inguinofemoral lymphadenectomy (IFL) in vulvar cancer patients with a metastatic sentinel node (SN).

METHODS

GROINSS-V-II was a prospective multicenter phase-II single-arm treatment trial, including patients with early-stage vulvar cancer (diameter < 4 cm) without signs of lymph node involvement at imaging, who had primary surgical treatment (local excision with SN biopsy). Where the SN was involved (metastasis of any size), inguinofemoral radiotherapy was given (50 Gy). The primary end point was isolated groin recurrence rate at 24 months. Stopping rules were defined for the occurrence of groin recurrences.

RESULTS

From December 2005 until October 2016, 1,535 eligible patients were registered. The SN showed metastasis in 322 (21.0%) patients. In June 2010, with 91 SN-positive patients included, the stopping rule was activated because the isolated groin recurrence rate in this group went above our predefined threshold. Among 10 patients with an isolated groin recurrence, nine had SN metastases > 2 mm and/or extracapsular spread. The protocol was amended so that those with SN macrometastases (> 2 mm) underwent standard of care (IFL), whereas patients with SN micrometastases (≤ 2 mm) continued to receive inguinofemoral radiotherapy. Among 160 patients with SN micrometastases, 126 received inguinofemoral radiotherapy, with an ipsilateral isolated groin recurrence rate at 2 years of 1.6%. Among 162 patients with SN macrometastases, the isolated groin recurrence rate at 2 years was 22% in those who underwent radiotherapy, and 6.9% in those who underwent IFL (P = .011). Treatment-related morbidity after radiotherapy was less frequent compared with IFL.

CONCLUSION

Inguinofemoral radiotherapy is a safe alternative for IFL in patients with SN micrometastases, with minimal morbidity. For patients with SN macrometastasis, radiotherapy with a total dose of 50 Gy resulted in more isolated groin recurrences compared with IFL.

Diagnostic Reliability, Accuracy and Safety of Ultrasound-guided Biopsy and Ascites Puncture in Primarily Inoperable Ovarian Tumours

BACKGROUND/AIM

To compare the diagnostic reliability, accuracy and safety of ultrasound-guided biopsy (Tru-Cut biopsy) and ascites puncture in patients with a primarily inoperable malignant ovarian tumor.

PATIENTS AND METHODS

This is a retrospective analysis of the studied methods in consecutively examined patients and a prospective validation of these methods. 79 women with a suspected primarily inoperable ovarian tumor underwent Tru-Cut biopsies and were included in the ultrasound-guided biopsy group. In addition, 55 patients after ascites puncture were enrolled in the comparison group. Both procedures were performed in 48 patients for the prospective validation.

RESULTS

Significant differences in favour of ultrasound-guided biopsy were found in all studied variables (malignancy confirmation 72.9% vs. 95.8%, tumor origin 52.1% vs. 89.6%, histologic subtype 43.8% vs. 85.4% and accuracy, i.e. agreement of preoperative and definitive diagnosis 43.7% vs. 95.4%).

CONCLUSION

Ultrasound-guided biopsy is an accurate, reliable, safe and minimally invasive method. Owing to the high reliability and accuracy, it has the capacity to replace ascites puncture with cytologic examination or a more invasive method (laparoscopy, laparotomy) for adequate tumor sampling.

Coincidence of giant uterine myomatosis and detection of two advanced malignancies in 77-year-old female patient

OBJECTIVE

Our aim is to emphasize the importance of patient participation in screening programs available in the Czech Republic and in preventive gynaecological examinations. As an example, we present a case report of a 77-year-old female patient with the accumulation of serious gynaecological diseases (extreme uterine myomatosis, breast cancer) and non-Hodgkin´s B-lymphoma.

DESIGN

Case report.

SETTING

Department of Obstetrics and Gynaecology, Faculty Hospital in Pilsen, Charles University Medical Faculty in Pilsen.

CASE REPORT

Our case report of a 77-year-old patient is a rare case of the simultaneous detection of giant uterine myomatosis causing voluminous ventral hernia, invasive ductal breast cancer, and non-Hodgkin´s B-lymphoma. The patient was not gynecologically examined for last 20 years and did not undergo any screening examinations. In the postoperative period, the patient was diagnosed with invasive ductal breast cancer and follicular lymphoma. All the diseases were diagnosed in advanced stage.

CONCLUSION

The occurrence of bulky fibroids is very rare in postmenopause. Long-term neglect of clinical symptoms and adverse health signals allows their gradual progression. Especially in older patients, other serious illnesses may complicate the situation.

Association of ABC gene profiles with time to progression and resistance in ovarian cancer revealed by bioinformatics analyses

Introduction

Ovarian cancer (OC) represents a serious disease with high mortality and lack of efficient predictive and prognostic biomarkers. ATP‐binding cassette (ABC) proteins constitute a large family dedicated to active transmembrane transport including transport of xenobiotics.

Materials and methods

mRNA level was measured by quantitative RT‐PCR in tumor tissues from OC patients. Bioinformatics analyses were applied to two gene expression datasets (60 primary tumors and 29 peritoneal metastases). Two different approaches of expression data normalization were applied in parallel, and their results were compared. Data from publically available cancer datasets were checked to further validate our conclusions.

Results

The results showed significant connections between ABC gene expression profiles and time to progression (TTP), chemotherapy resistance, and metastatic progression in OC. Two consensus ABC gene profiles with clinical meaning were documented. (a) Downregulation of ABCC4, ABCC10, ABCD3, ABCE1, ABCF1, ABCF2, and ABCF3 was connected with the best sensitivity to chemotherapy and TTP. (b) Oppositely, downregulation of ABCB11 and upregulation of ABCB1 and ABCG2 were connected with the worst sensitivity to chemotherapy and TTP. Results from publicly available online databases supported our conclusions.

Conclusion

This study stressed the connection between two well‐documented ABC genes and clinicopathological features—ABCB1 and ABCG2. Moreover, we showed a comparable connection also for several other ABC genes—ABCB11, ABCC4, ABCC10, ABCD3,ABCE1, ABCF1, ABCF2, and ABCF3. Our results add new clinically relevant information to this oncology field and can stimulate further exploration.

[One-Step Nucleic Acid Amplification method - what is the future of sentinel lymph node management?]

OBJECTIVE

The article summarizes current possibilities of usage of the One-Step Nucleic Acid Amplification method (OSNA) in the perioperative management of sentinel lymph nodes in oncologic surgery. The principle of this method is the detection of cytokeratin 19 (CK19) in the lymphatic tissue as a marker of the metastatic spread.

DESIGN

Review article.

SETTINGS

Department of Obstetrics and Gynaecology, University Hospital Pilsen, Faculty of Medicine in Pilsen, Charles University, Prague; Department of Biology, Faculty of Medicine in Pilsen, Charles University, Prague; Department of Immunochemistry, University Hospital Pilsen, Faculty of Medicine in Pilsen, Charles University, Prague; Sikl´s Department of Pathology, University Hospital Pilsen, Faculty of Medicine in Pilsen, Charles University, Prague.

METHODS

The review of the literature published until the end of April 2017 available on the PubMed database was performed. The official abbreviation OSNA and the full name of the method One-Step Nucleic Acid Amplification was used for search in this database.

CONCLUSION

The usage of the OSNA method with the detection of CK 19 in the sentinel lymph nodes as a marker of metastatic spread to the lymphatic tissue currently represents an acceptable form of perioperative sentinel lymph node management in patients with breast and colorectal cancer. Until now published data are pointing towards possible successful application of this method in sentinel lymph node management in patients with some other malignancies, such as thyroid carcinoma, gastric cancer, uterus cancer and head and neck cancer. More data is needed to establish this method also in those neoplasms.

Significance of bizarre cells in cervical screening liquid-based cytology: A prospective study of 15 cases

OBJECTIVE

The aim of this study was to assess the significance of bizarre cells (cells of squamous origin with a superficial squamous cell-type cytoplasm and characterised by multinucleation that produces bizarre nuclear shapes) in liquid-based cytology (LBC) Papanicoaou (pap) smears with clinical and histological follow-up correlation.

METHODS

Fifteen patients, all with LBC samples containing bizarre cells, were identified in routine ThinPrep^® LBC workload. HPV testing was performed in each case using residual LBC material. Cytological-histological correlations were reviewed.

RESULTS

All 15 LBC samples contained bizarre cells and tested positive for high-risk HPV types. Ten of the 15 cases were identified as atypical squamous cells - cannot exclude an HSIL (ASC-H) with secondary diagnosis of low-grade squamous intraepithelial lesion (LSIL), while five cases were identified as high-grade squamous intraepithelial lesion (HSIL), and a subsequent biopsy was recommended. Additionally, 13/15 cases underwent cone biopsy or hysterectomy within 1-11 months, of which 10 showed histologically confirmed HSIL end-points. LSIL was present in three cases. Bizarre cells were identified in the HSIL epithelium of five cone biopsies.

CONCLUSIONS

Identification of bizarre cells in LBC is straightforward and may facilitate diagnosis. The cytology of bizarre cells is associated with HSIL in cone biopsies. We recommend assigning LBC samples containing bizarre cells as ASC-H with secondary diagnosis of LSIL.

Gene Expression Profiling Reveals Novel Candidate Markers of Ovarian Carcinoma Intraperitoneal Metastasis

Epithelial ovarian cancer (EOC) has the highest mortality among gynecological carcinomas. The lack of specific markers for prognostic determination of EOC progression hinders the search for novel effective therapies.

The aim of the present study was (i) to explore differences in expressions of ATP-binding cassette (ABC) and solute carrier (SLC) transporter genes, genes associated with drug metabolism and cell cycle regulation between control ovarian tissues (n = 14), primary EOCs (n = 44) and intraperitoneal metastases (n = 29); (ii) to investigate associations of gene expression levels with prognosis of patients with intraperitoneal metastases.

In all tissue samples, transcript levels of the above target genes were assessed using quantitative real-time PCR. Gene expression levels were compared between particular tissue types and evaluated with regard to progression-free survival (PFS) and drug-resistance status of patients with metastases.

Gene expression of ABCA7 significantly increased and that of ESR2 decreased in the order control ovarian tissues - primary EOCs - metastases. High expressions of ABCA2/8/9/10, ABCB1, ABCC9, ABCG2, ATP7A, SLC16A14, and SOD3 genes were significantly associated with longer progression-free survival of patients. In intraperitoneal metastases, expression of all of these genes highly correlated and indicated prognostic profile. Transporters from the ABCA family, ABCG2, and ESR2 are involved mainly in lipid metabolism, membrane transport, and cell proliferation. These processes are thus probably the most important for EOC progression.

Based on these results, we have proposed novel markers of ovarian carcinoma progression and metastatic spread which might be potentially useful as therapeutic targets. Their significance should be further explored on a larger independent set of patients.

CD44 as a cancer stem cell marker and its prognostic value in patients with ovarian carcinoma

The aim of our study was to clarify whether the CD44 adhesion molecule as a cancer stem cell marker could also serve as a prognostic factor in patients with epithelial ovarian cancer (EOC). A retrospective study was performed on 87 patients with histologically verified EOC. Specimens of both primary tumour and implantation metastases were tested from 48 of them. CD44 expression was detected by immunohistochemistry. We looked for the cut-off levels of CD44 expression using the Cox regression model. We confirmed statistically significant prognostic factors for overall survival (OS) and disease-free interval (DFI) to be: stage of the disease, postoperative residual tumour and papillary serous histological type. We demonstrated a statistically significant correlation between low CD44 expression and serous papillary carcinoma histotype, tumour recurrence and chemoresistance at a value below 2%. CD44 was neither a prognostic factor of OS nor of DFI. IMPACT STATEMENT What is already known about this subject: Epithelial ovarian cancer is the second most common gynaecological cancer in developed countries. Despite great efforts devoted to ovarian cancer research during past decades, levels of patient mortality have changed very little. Cancer stem cells (CSCs) are subpopulations of cells with typical characteristics of stem cells - i.e. the ability to self-renew and differentiate in a variety of cell types. The main surface marker typical for CSCs is CD44. The aim of our study was to clarify whether the CD44 as a CSCs marker could serve as a prognostic factor in patients with epithelial ovarian cancer. Previous studies published on this topic revealed controversial results. The novelty of our study lies in looking for the cut-off using the Cox regression model.

WHAT THIS STUDY ADDS

We demonstrated a statistically significant correlation between low CD44 expression and serous papillary carcinoma histotype, tumour recurrence and chemoresistance at a value below 2%, however, CD44 was neither a prognostic factor of overall survival nor of disease-free interval. We propose to investigate other markers including other CSCs as a prognostic factors or potential aims for targeted therapy in ovarian cancer.

Cyr61 Expression Pattern and Association with Clinicopathological Factors in Patients with Cervical Cancer

BACKGROUND/AIM

The pro-angiogenic Cyr61 protein has been associated with tumorigenesis and cancer progression in different gynecological carcinomas. In this study, we evaluated the potential impact and clinical relevance of Cyr61 expression in patients with primary non-metastatic cervical cancer (CC).

PATIENTS AND METHODS

Cyr61 expression was assessed in tissue specimen of 48 patients with primary CC by immunohistochemical analysis. Expression levels were scored and correlated to clinico-pathological factors and outcome data.

RESULTS

High Cyr61 expression levels were present in 54.2% of CC tissues. Associations with histological grade (p=0.030), depth of tumor invasion (p=0.007) and GOG score (p=0.027) were observed. Patients who overexpressed Cyr61 displayed an increased death rate (30.8% vs. 18.2%) and a decreased 5-year-survival (76.9% vs. 86.4%).

CONCLUSION

Our data indicate a potential functional impact of Cyr61 in development and the progression of CC. The definite tumor-relevant function (suppressive/promoting) of Cyr61 in CC and the prognostic relevance of Cyr61 overexpression has to be evaluated in larger cohorts.

Importance of Preoperative Knowledge of the Biomarker HE4 in Early-stage Endometrial Cancer Regarding Surgical Management

AIM

To analyze the utility of HE4 assessment in preoperative management of patients with early-stage endometrial cancer for stratification into low-risk and high-risk groups.

PATIENTS AND METHODS

The following data were prospectively collected from patients operated for endometrial cancer from 05/2012 till 9/2016; age, HE4, CA125, expert ultrasound examination of the pelvis, histotype, grade, FIGO stage.

RESULTS

In total, 124 patients were enrolled. A cut-off of ≥113 pmol/l HE4 demonstrated 40.3% sensitivity and 83.9% specificity for detection of high-risk patients. Correlations of HE4 with age (p<0.001), depth of myometrial invasion (p=0.001), clinical stage of the disease according to ultrasound - T1a vs. T1b (63.6 pmol/l vs. 110.6 pmol/l, p<0.001) were found. However, no correlation of HE4 with lymph node invasion (p=0.07) and tumor grade (p=0.212) was identified.

CONCLUSION

HE4 levels correspond to clinical and FIGO stage of the disease. The sensitivity and specificity does not reach the transvaginal ultrasound results in preoperative assessment of the extent of the disease. Combination of HE4 with ultrasound does not improve the stratification of patients into low-risk and high-risk groups. Preoperative assessment of HE4 is useful providing no imaging method is available.

[Carcinosarcoma of the endometrium with melanocytic differentiation, case report]

OBJECTIVE

The case report presents a case of 60-year old woman with a rare malignant mixed Müllerian tumor with melanomatous differentiation diagnosed from a histology after cervical polyp ablation and curettage.

DESIGN

Case report.

SETTING

Department of gynecology and obstetrics, University Hospital in Pilsen.

CONCLUSION

Carcinosarcoma, previously malignant mixed Müllerian tumor, is a very rare aggressive endometrial carcinoma with low incidence, which typically occurs among older women and commonly affects the uterine body and cervix. Clinically, the carcinosarcoma is impossible to be distinguished from endometrial carcinoma or uterine sarcoma and the definitive diagnosis can only be made based on histological examination.

Incidence of uterine sarcomas in West Bohemia, at the Department of Gynaecology and Obstetrics, University Hospital in Pilsen, Czech Republic

OBJECTIVE AND SETTING

A retrospective review of women of the West Bohemian population was performed at the Department of Gynaecology and Obstetrics, University Hospital in Pilsen, Czech Republic from 1/2005 - 1/2017.

METHODS

The following data was analysed: patients age, histological type, tumour size, FIGO stage, body mass index, previous irradiation, Tamoxifen usage, and other possible risk factors. A total number of 20 uterine sarcoma patients were detected in the period from 1/2005 to 1/2015, and these cases were followed until 1/2017.

RESULTS

The histological types identified were: leiomyosarcoma in 12 cases, endometrial stromal sarcoma in 7 cases and one case of high-grade undifferentiated uterine sarcoma. This only patient diagnosed with high-grade undifferentiated uterine sarcoma showed distant metastases 12 months after the surgical treat-ment and died one month later. The whole group of uterine sarcoma patients regardless histological subtype reached two years in 50% of cases, with the median disease-free interval 18 months and the median follow up of 38 months. The diagnosis of sarcoma was already known in 25% of cases from dilatation and curettage histology. There were suspicious sonographic findings suggestive of sarcoma in 10% of cases. Multiparity was associated with 48.2% of endometrial stromal sarcoma cases. The leading clinical symptom was postmenopausal bleeding in 55% of patients.

CONCLUSION

We confirmed uterine sarcomas to be rare malignancies, even in the Czech population with high uterine malignancy incidence. Uterine cold knife morcellation during the vaginal part of laparoscopically assisted vaginal hysterectomy didnt worsen the prognosis of our patients.

Gene expression of membrane transporters: Importance for prognosis and progression of ovarian carcinoma

Membrane transporters (such as ABCs, SLCs and ATPases) act in carcinogenesis and chemoresistance development, but their relevance for prognosis of epithelial ovarian cancer (EOC) remains poorly understood. We evaluated the gene expression profile of 39 ABC and 12 SLC transporters and three ATPases in EOC tissues and addressed their putative role in prognosis and clinical course of EOC patients. Relative gene expression in a set of primary EOC (n=57) and in control ovarian tissues (n=14) was estimated and compared with clinical data and survival of patients. Obtained data were validated in an independent set of patients (n=60). Six ABCs and SLC22A18 gene were significantly overexpressed in carcinomas when compared with controls, while expression of 12 ABCs, five SLCs, ATP7A and ATP11B was decreased. Expression of ABCA12, ABCC3, ABCC6, ABCD3, ABCG1 and SLC22A5 was higher in high grade serous carcinoma compared with other subtypes. ABCA2 gene expression significantly associated with EOC grade in both sets of patients. Notably, expression level of ABCA9, ABCA10, ABCC9 and SLC16A14 significantly associated with progression-free survival (PFS) of the disease in either pilot or validation sets. ABCG2 level associated with PFS in the pooled set of patients. In conclusion, ABCA2, ABCA9, ABCA10, ABCC9, ABCG2 and SLC16A14 present novel putative markers of EOC progression and together with the revealed relationship between ABCA12, ABCC3, ABCC6, ABCD3, ABCG1 and SLC22A5 expression, and high grade serous type of EOC should be further examined by larger follow-up study.

[Agressive small cell carcinoma of the ovary, hypercalcemic type, surgery and oncological treatment: case report]

Small cell carcinoma of the ovary (SCCOHT) is a rare tumor typically affecting young women. It is a highly malignant tumor accompanied with poor prognosis, early relapse and low survival rates. The most significant prognostic factor is stage of the disease. Due to above mentioned factors there are no guidelines for therapy of this rare tumor. We present a case of 22-years-old patient initially treated with antibiotics under diagnosis of pelvic inflammatory disease. Due to persistent mass at left adnexa, she was indicated for diagnostic laparoscopy, converted to laparotomy and left adnexectomy with frozen section revealing unspecified malignant tumor of left ovary. A conservative operation was performed and, after diagnosis of SCCOHT was established, the patient was indicated for adjuvant chemotherapy.

[Non-neoplastic epithelial disorders of the vulva - lichen sclerosus]

Lichen sclerosus (LS) belongs to frequent non-neoplastic epithelial disorders of the vulva. LS is a disease of unknown ethiology, affecting mainly postmenopausal women. LS has a typical macroscopic pattern, and it is characterized with an intensive pruritus and dyspareunia. Patients with LS have a risk of scarring of external genitalia and risk of developing squamous cell carcinoma of the vulva (4-5%). Treatment of LS is usually long-term, repeated, and it is based on local potent corticosteroids. Frequent reccurences require repeated therapy. A close follow-up in a 6-months intervals and biopsy of all atypical lesions is required. Surgical treatment is rarely indicated in the management of LS. Follow-up at the specialized center is recommended.

[Detection of cancer stem cells in ovarian cancer]

OBJECTIVE

Detection of cancer stem cells (CSCs) in ovarian cancer, influence of CSCs on overall survival, disease free interval. Results in comparison with literature.

DESIGN

Original study.

SETTINGS

Department of Gynaecology and Obstetrics, Faculty Hospital Pilsen and Medical Faculty in Pilsen, Charles University, Šikls Institute of Pathology, Faculty Hospital Pilsen and Medical Faculty in Pilsen, Charles University.

METHODS

23 specimens of papillary-serous ovarian carcinoma and 4 specimens of endometroid ovarian carcinoma were included in the study. Specific antibodies to CD44 and CD133 antigens were used. Immunoreaction of both CD44 and CD133 was evaluated for the high power field.

RESULTS

There was no significant correlation between CD44 expression and disease free interval and overall survival. CD133 expression was not evaluated due to an inadequate immunoreaction antibody - antigene.

CONCLUSION

We did not find any statistically correlation between CD44 expression and overall survival and disease free interval in our series of patients with ovarian carcinoma. It seems to be better to use different antibody for CD133 detection.

[Evaluation of p16 protein in the managementof cervical dysplasia]

OBJECTIVE

Protein p16 as an important cell-cycle inhibitor is a promising diagnostic and prognostic factor of cervical dysplasia. In our study we evaluate the impact of p16 protein evaluation on management of cervical dysplasia.

DESIGN

Retrospective study.

SETTING

Department of Obstetrics and Gynecology, Medical Faculty Pilsen, Charles University Prague.

METHODS

A retrospective study was performed on 122 consecutive patients with colposcopically-directed cervical biopsy (CDB) with following excisional procedure (LEEP or cold-knife conisation). P16 expression in the specimen from CDB was independently evaluated using immunohistochemistry in all patients. Relation among CDB histology, p16 expression, and final histology from excisional procedure was analysed.

RESULTS

In our series, we identified 44 CIN 1 and 61 CIN 2/3 in CDB specimens. In the CIN 1 group, 15 cases (34.1%) were p16 negative and 29 (65.9%) cases were p16 positive. In CIN 1 p16 negative group, only 2 of 15 patients (13.3%) had CIN 2/3 in the final histology comparing to 19 of 29 patients (65.5%) in CIN 1 p16 positive group (statistically signifiant,p < 0,05; Wilcoxon test). In CIN 2/3 group, 60 (98.4%) specimen were p16 positive and 57 patients (93.4%) had also CIN 2/3 in the final histology.

CONCLUSION

In our study of 122 patients with CDB we found that in group of CIN 1 patients, p16 evaluation had significant predictive value for final histology. In the group of patients with CIN 2/3, 98% specimens were p16 positive and therefore p16 evaluation had no prognostic impact on final histology. Prospective study is needed to confirm this data.

Weak expression of focal adhesion kinase (pp125FAK) in patients with cervical cancer is associated with poor disease outcome

PURPOSE

The pp125 focal adhesion kinase (FAK) plays a pivotal role in tumor cell signaling. FAK expression has been linked to tumor cell invasion and metastasis, but data on cervical cancer are inconclusive. Our goal was to investigate FAK expression in cervical cancer and to assess whether its expression correlates with prognosis.

EXPERIMENTAL DESIGN

FAK expression was examined using immunohistochemistry with sections from 162 resected cervical cancer specimens. Kaplan-Meier survival curves were used to determine the significance of FAK expression in the prognosis of cervical cancer patients.

RESULTS

Specific FAK expression was found in the tumor cells, whereas normal cervical epithelium showed barely any FAK expression. Of 162 invasive cervical cancer specimens, 55 (34%) revealed weak expression of FAK, whereas moderate and strong expression was found in 63 (39%) and 44 (27%) tumors, respectively. Patients with tumors expressing weak amounts of FAK were characterized by a significantly poorer overall survival compared with those with moderate and high intratumoral FAK expression (P = 0.002). Weak expression of FAK correlated with pelvic lymph node metastasis (P = 0.026) and recurrent disease (P = 0.013). Multivariate Cox regression analysis revealed decreased FAK expression and pelvic lymph node metastasis to be significant independent factors predictive of poor disease outcome (hazard ratio, 0.36; P = 0.005; hazard ratio, 2.38; P = 0.018, respectively).

CONCLUSIONS

Weak expression of FAK in invasive cervical cancer is a strong independent predictor of poor patient outcome. Further studies are warranted to elucidate whether FAK expression analysis is a suitable tool identifying patients at high risk even at an early clinical stage.

Primary cutaneous histiocyte and neutrophil-rich CD30+ and CD56+ anaplastic large-cell lymphoma with prominent angioinvasion and nerve involvement in the forehead and scalp of an immunocompetent woman

BACKGROUND

Cutaneous lymphomas co-expressing CD56 and CD30 are very rare. They share a clinicopathological overlap with natural killer- (NK)/T-cell lymphomas and anaplastic large-cell lymphomas (ALCLs), two entities with widely disparate clinical behavior.

METHODS

We present a case of an immunocompetent 57-year-old Caucasian woman with a rapidly growing, angiodestructive and neuroinvasive primary cutaneous ALCL (PCALCL). The neoplastic population of large anaplastic CD30+ and CD56+ T cells was masked by a massive admixture of histiocytes and neutrophils. The partially ulcerated and pus-secreting tumor involved the forehead and scalp and was assessed as clinical stage IAE.

RESULTS

After chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone), the patient achieved a complete remission. Additionally, high-dose chemotherapy with autologous peripheral blood stem-cell transplantation was administered as a consolidation of complete remission, in which she has remained for 6 years.

CONCLUSIONS

This is the first CD30+ and CD56+ primary skin lymphoma to be reported on the head. The presented case carries a remarkable combination of clinicopathological features of PCALCL and NK-/T-cell lymphoma.

[Neurological complications during gynecological pelvic surgery]

OBJECTIVE

To summarize literary data dealing with neurological complications during gynecological pelvic surgery and present a case report.

DESIGN

Literary review and a case report.

SETTING

Department of Obstetrics and Gynecology, Medical Faculty Hospital Plzen.

METHODS

Literary review of lesions of cerebrospinal nerves during gynecological pelvic surgery, case report.

CONCLUSION

Neurological complications of pelvic surgery are usually discreet and their diagnosis is often delayed. A close cooperation with neurologists and anestesiologists is necessary.

Hidradenoma Papilliferum with Oxyphilic Metaplasia

Reported here are 18 cases of hidradenoma papilliferum with oxyphilic metaplasia. All patients were women ranging in age from 29 to 74 years. Each presented clinically with a small, solitary tumor in the anogenital region. Microscopically, in addition to classic histopathological features, in every case there was oxyphilic metaplasia of the constituent epithelial cells. This finding could be likened to apocrine metaplasia, a term used in breast pathology. Other histopathological findings observed in this series, analogous to benign breast disease, included sclerosing adenosis-like changes, atypical apocrine adenosis-like changes, changes corresponding to usual ductal epithelial hyperplasia, epitheliomatosis with a streaming growth pattern, lamprocyte-like changes, clear cell change of the myoepithelium, foamy histiocyte reaction, and stromal fibrosis. Immunohistochemistry inferred that in the majority of cases oxyphilic metaplasia resulted from more lysosomes, whereas numerous mitochondria were detected in only 3 cases. Using 2 different PCR methods we identified HPV in 4 of 15 cases of hidradenoma with oxyphilic metaplasia. In addition, HPV was detected in 3 of 16 conventional papillary hidradenomas used as a control group. The following HPV types were identified: 16, 31, 33, 53, and 56. The last type was found in 5 cases. More than one HPV type from a single lesion was seen in 5 cases. Our observations are consistent with previous publications noting similarities between tumors of the breast and sweat glands. Oxyphilic metaplasia, areas with solid growth, and changes simulating atypical apocrine adenosis are rare and poorly recognized in hidradenoma papilliferum and may cause diagnostic difficulties; in our cases several submitting pathologists suspected malignancy. A causal role for HPV in hidradenoma papilliferum cannot be confirmed from our results, as the detection rate is too low. The exact role of the HPV in etiology and pathogenesis of this neoplasm has yet to be determined.

CD44v6 as a prognostic factor in cervical carcinoma FIGO stage IB

The aim of our study was to clarify whether CD44v6 evaluation can serve as a universally applicable prognostic factor in patients with FIGO stage IB cervical carcinoma. A retrospective study was performed on 178 FIGO stage IB (142 IB N0, 36 IB N1) radically operated cervical carcinoma patients. The expression of CD44v6 was investigated by immunohistochemistry (IHC). The prognostic significance of established prognostic factors and CD44v6 expression was analyzed by univariate and multivariate analyses. To test the reproducibility and to account for interobserver variability, all specimens were evaluated independently at two institutions. Two different IHC scoring systems, several cut-off levels for CD44v6 positivity and several statistical methods for IHC results evaluation were used. In a univariate analysis, the most significant prognostic factor for overall survival (OS) was lymph node status (p<0.001) followed by tumor volume, LVSI, GOG score (p<0.01) and a deep stromal invasion (p = 0.06). We found a strong correlation between CD44v6 expression and squamous cell carcinoma (SCC) (SCC vs. adenocarcinoma - p<0.001) and between CD44v6 expression and deep stromal invasion, LVSI and GOG score (p<0.05). The CD44v6 expression was not a statistically significant prognostic factor for OS in a univariate analysis (p=0.39 Vienna; p=0.54 Freiburg). In a multivariate analysis, the most significant prognostic factor for OS was lymph node status (p =0.002), followed by tumor diameter and LVSI (p<0.05). CD44v6 expression was not a statistically significant prognostic factor for OS or disease-free interval (DFI) independent of the scoring method used. In conclusion, we demonstrated that CD44v6 expression is associated with LVSI, deep stromal invasion and SCC, but has no prognostic influence on OS and DFI in a population of 178 women with FIGO stage IB cervical carcinoma.

[Prognostic factors of the cervical carcinoma]

OBJECTIVE

Review of prognostic factors of the cervical carcinoma, new perspective methods.

SETTING

Department of Obstetrics and Gynecology, Medical Faculty Hospital, Plzen.

DESIGN

Review article.

RESULTS

The most important prognostic factors of the early cervical carcinoma are the stage and regional lymph node status followed by the depth of stromal invasion, tumor volume, and lymphovascular invasion. Other factors are still only subjects of research.

CONCLUSION

A detailed knowledge of particular prognostic factors of the cervical carcinoma is necessary for optimal treatment and flow-up strategy.

[Clinical relevance of tumor markers in epithelial ovarian cancer]

AIM OF STUDY

The authors present the view of possible usage of tumour markers in epithelial ovarian cancer, and they aim at their use in routine clinic practice.

TYPE OF STUDY

Review article.

SETTING

Oncology and Radio-Therapeutic Department, Faculty Hospital, Pilsen. SUBJECT AND METHODS OF THE STUDY: Summary of data published in Czech and foreign professional literature.

CONCLUSION

In case of epithelium tumours of ovaries, CA 125 is the tumour marker of the first choice. For the reason of low sensitivity, it is not possible to use the tumor markers for screening and primary diagnostics. Regarding prognoses, high pre-operational levels of CA 125 are considered unfavourable. At the same time the study demonstrates that CA 125 levels monitoring in the course of chemotherapy appears to be one of the most significant indicators of chemotherapy effects and, therefore, also of prognoses. Regular CA 125 monitoring in the course of follow up can contribute to early detection of tumour disease relapses. The optimal time interval for monitoring seems to be three months for the period of the first two years, and then six-month interval. Other tumour markers used in routine clinic practice are mainly CA 19-9 and CA 72-4, particularly in case of mucinoid epithelium tumours. However, these markers are of subsidiary importance only.

[Role of p27Kip1 protein in the cell cycle and its appearance in lymphoid tissues, particularly non-Hodgkin's B-cell lymphomas. Review]

Cell cycle progression is governed by cyclin dependent kinases (CDK) that are activated by cyclin binding and inhibited by CDK inhibitors. Protein p27Kip1 functions as a CDK inhibitor, which controls the progression from G1 to S phase. Further, p27Kip1 may have a positive regulative influence. In nonneoplastic tissues and in the majority of tumors investigated so far, the immunohistochemical positivity of p27Kip1 showed an inversely proportional relationship to the proliferation index. Among B-cell non-Hodgkin lymphomas, the exceptions to this rule are represented by mantle cell lymphoma, hairy cell leukemia, and the immunoblastic Epstein-Barr virus latent membrane antigen positive diffuse large B-cell lymphoma in AIDS patients. The loss of p27Kip1 expression is a negative prognostic factor in numerous tumors, including the majority of B-cell lymphomas.

[Endometrial ablation and resection techniques]

OBJECTIVE

To summarize all currently used and experimental, hysteroscopic and non-hysteroscopic methods of endometrial ablation and resection, their indications, operation techniques, and treatment results.

DESIGN

Literary review.

SETTING

Department of Obstetrics and Gynecology, Medical Faculty and Faculty Hospital, Charles university, Capkovo námĕstí 1, Plzen, Czech Republic.

METHODS

Analysis of the literature (textbooks, medical journals, database Medline, Current Contents, Embase, PubMed).

RESULTS AND CONCLUSION

Endometrial ablation and resection play an important role in the treatment of dysfunctional uterine bleeding. Hysteroscopic methods visualize the uterine cavity and enable to treat lesions in it at the same time. Non-hysteroscopic methods are less invasive for the patient and comfortable for the surgeon. Both groups of methods have similar treatment results.

Blood acid-base and serum electrolyte values in red deer (Cervus elaphus)

Acid-base, serum electrolyte, plasma protein, and packed cell volume (PCV) values were determined in venous blood samples from 30 red deer (Cervus elaphus) of both sexes showing no clinical signs of disease. The animals were 5 months of age and kept on pasture in the Valley of Mexico, at an altitude of 2450 m. Blood samples were collected without sedation. Mean blood values were: pH 7.411 +/- 0.041, pCO2 37.7 +/- 4.4 mmHg, base excess 0.7 +/- 3.2 mmol/L, actual bicarbonate 24.3 +/- 3.1 mmol/L, total CO2 25.3 +/- 3.2 mmol/L and anion gap 23.5 +/- 5.5 mmol/L. Mean serum electrolyte levels were: Na+ 142.3 +/- 2.5 mmol/L, Cl- 100.5 +/- 2.3 mmol/L, and K+ 7.03 +/- 1.03 mmol/L. Plasma protein and PCV values were 60.0 +/- 6.6 g/L and 0.47 +/- 0.05 L/L, respectively. Blood values determined in this study can be considered reference data for health control and disease diagnosis.

[Hysteroscopic polypectomy versus fractionated curettage in the treatment of corporal polyps--recurrence of corporal polyps]

OBJECTIVE

The evaluation of hysteroscopy contribution in the treatment of endometrial polyp. The evaluation of the risk of endometrial polyp recurrence.

DESIGN

Prospective clinical study.

SETTING

Department of Obstetrics and Gynecology of Medical faculty and Faculty Hospital, Pilsen.

METHODS

Two groups of patients were followed. Group I had 81 patients (30 premenopausal and 51 postmenopausal) that underwent hysteroscopical polypectomy followed by diagnostic hysteroscopy in 6-12 months. Group II consisted of 100 patients (36 premenopausal and 64 postmenopausal) that underwent fractional curretage with histological diagnosis of endometrial polyp. These patients were checked by diagnostic hysteroscopy in up to 12 months. Presence of endometrial polyp during diagnostic hysteroscopy and a relation of its recurrence or persistence to a type of preceding procedure, risk factors and histological findings during the first procedure were evaluated.

RESULTS

11 (13.5%) cases of an endometrial polyp were recorded in hysteroscopical controls in group I. 46 (46%) cases of an endometrial polyp were recorded in group II. Recurrence of the endometrial polyp was revealed only in one case of atrophic endometrium and in no case of atrophic endometrial polyp.

CONCLUSION

Hysteroscopical polypectomy showed considerably better results in the treatment of endometrial polyp comparing to fractional curretage. The recurrence risk of endometrial polyp is expected in a case of presence of an abnormal proliferative activity or hyperplasia both in the endometrial polyp and the surrounding endometrium.

[Malignant gynecologic neoplasms in the Czech Republic 1986-1995]

OBJECTIVE

The incidence and mortality of malignant tumours of the uterine cervix, uterine body and ovary are analysed.

DESIGN

Retrospective study.

SETTING

Department of Obstetrics and Gynecology, Medical Faculty and Faculty Hospital, Charles University, Plzen.

METHODS

Analysis of relevant dates from the National Oncological Registry 1986-1995.

RESULTS

The incidence of the cervical carcinoma oscilated around 22 (22.7-21.6), the mortality slightly decreased (9.6-8.4). The incidence of the corpus carcinoma rose again (25.9-28.9), its mortality declined (7.4-6.9). The incidence of malignant ovarian tumours significantly increased (16.3-23.4), the mortality became slightly higher (14.8-16.2). The incidence of the ovarian carcinoma got ahead the incidence of the cervical carcinoma (23.4:21.6) and it occupied the second place after the corpus carcinoma.

CONCLUSIONS

It is necessary to screen systematically gynecological malignant tumours and concentrate its treatment to specialized centers. Correct reports of these tumours and their precise staging is needed, too.

An unusual case of malignant Brenner tumor in association with low-grade urothelial carcinoma of the urinary bladder. A case report

We present a case of a 45-year-old Caucasian female with a malignant Brenner tumor arising at the site of the right ovary 21 years after right adnexectomy performed for ectopic pregnancy. Several months after the presentation of the malignant Brenner tumor the patient was diagnosed with low-grade urothelial carcinoma of the urinary bladder. All clinical, biochemical, and pathological findings with the emphasis on the differential diagnosis are summarized. A brief survey of histological theories and classification of Brenner tumors as well as therapeutic approaches with their results are given. We have found a few papers [1, 2] dealing with the coexistence of Brenner tumors with urothelial ones, but to our knowledge the coexistence of both malignant tumors has not been published previously.

[Cervical glassy-cell carcinoma--case report]

OBJECTIVE

A rare case of a mixed cervical carcinoma is described.

SUBJECT

Glassy-cell carcinoma of the uterine cervix in association with a bilateral benign superficial serous papilloma of the ovary in a 44-year-old woman.

CONCLUSION

The possible occurrence of aggressive tumours of the uterine cervix with emphasis on their adequate treatment is pointed out. At the same time the importance of a peroperative biopsy of suspect macroscopic findings on the ovaries is stressed. The paper reports on a previously unpublished case of simultaneous occurrence of the above mentioned tumours.

[Zona pellucida antibody detection using the passive hemagglutination reaction. II. Clinical part]

The authors examined sera of patients suffering from idiopathic infertility, unsuccessful IVF, the diagnosis of habitual abortion and endometriosis, using the test of the passive haemagglutination reaction with sheep erythrocytes sensitized by 11 antigenic fractions of pig zona pellucida, molecular weights from 13.3-114 kilodaltons. The authors analyze the assembled results with regard to individual antigenic fractions and with regard to the diagnoses. The frequency of positive reactions in patients is investigated in particular in the area of higher molecular weights, as compared with the control group of healthy fertile women.

[Malignant ovarian neoplasms--a constant challenge to gynecologists]

The annual incidence of malignant neoplasms of the ovary has increased in the Czech Republic between 1961 and 1988 from 14.3 to 17.2 newly notified cases per 100,000 women. The highest incidence, 47.03, is in the age group from 70 to 74 years. It participates in the overall mortality from malignant tumours of the genitalia by 41.6%, although in the total incidence it accounts for 25%. The lethality calculated from the incidence and mortality in the Czech Republic in similar as in other countries--79%. This is consistent with the generally reported survival period after treatment which is 20-30%. Hospital statistics report more favourable results. Introduction of new therapeutic methods so far did not lead to marked improvement of therapeutic results. The latter are influenced more by detection of the disease in early stages.

[Epidemiology of malignant tumors of the uterus]

The authors describe the frequency, incidence, number of deaths and mortality from malignant tumours of the uterine corpus in the Czech Republic in 1961-1988. The mean incidence of 13.06 during the five-year period 1961-1965 rose to a mean incidence of 25.12 during the five-year period 1984-1988, while during this period a paradoxical decline of the mortality from 9.00 to 6.7 occurred. This implies a decline of the lethality during 1961-1965 from 76.56% to 28.98%, i.e. to 37.85% of the original value. The reasons of the decline in lethality may be earlier detection of the disease and possibly a rise in the incidence of less aggressive forms of hormone-dependent carcinomas only, because therapy did not change essentially during the mentioned period.

[Esophageal injuries]

The authors present an analysis of 33 oesophageal injuries treated at the surgical clinic of Faculty Hospital Plzen in 1976-1991. Iatrogenic injuries predominated (a total of 24 cases). Of these seven developed during oesophagoscopy performed on account of dysphagic complaints caused by benign or malignant disease. Ten injuries developed in conjunction with endoscopic extraction of a foreign body, three occurred during operation of hiatus hernia, two during sclerotization of oesophageal varices and one each during insertion of a nasogastric tube and oesophageal endoprosthesis. In the remaining cases perforation occurred during traumatic injury of the neck four times, twice as a result of a swallowed bone, and three perforations were spontaneous. The total mortality was 27.3%. The authors analyze factors which influence the morbidity and mortality--the site of injury, the time which elapsed between injury and treatment, the patient's age, mode of injury, associated diseases and method of treatment. They found that the most frequent complication and most frequent cause of death was septicaemia from mediastinitis and empyema of the chest.